194所三级医院ICU呼吸机相关性肺炎护理实践现状与对策

Investigation and analysis of nursing prevention and control of ventilator-associated pneumonia in ICUs of 194 tertiary hospitals

目的调查三级医院ICU呼吸机相关性肺炎(ventilator associate pneumonia,VAP)防控相关指南的护理实践现况,并分析相关对策。方法采用便利抽样法,于2021年9月1日—15日对26个省(区、市)194所三级医院380个ICU的护士进行调查。采用自行设计的调查问卷,包括ICU基本情况、VAP防控制度与流程、VAP防控重点环节实践现状3个部分。结果共发放380份问卷,回收有效问卷380份,有效问卷回收率为100%。在制度与流程方面,369个(97.11%)ICU有预防VAP相关文件;291个(76.58%)ICU有预防VAP集束化措施核查表,274个(72.11%)ICU最近3年病区有关于VAP的持续改进项目。在防控重点环节方面,338个(88.95%)ICU有创机械通气患者首选半卧位;224个(58.95%)ICU护理人员常规进行声门下吸引,128个(33.68%)ICU护理人员使用气流冲击法清除气囊上滞留物,仍有72个(18.95%)ICU护理人员在吸痰前常规滴注生理盐水;253个(66.58%)ICU护理人员口腔护理频率为3~4次/d;313个(82.37%)ICU使用气囊压力表间断监测气囊压力;293个(77.11%)ICU呼吸机管路更换频率为1次/周。在提高床头抬高依从性的策略、声门下分泌物引流、气囊压力监测、口腔护理等方面,不同类型ICU的实践现状均具有差异(P<0.05)。结论三级医院ICU已有VAP预防相关文件及制度,重视VAP持续质量改进,但不同医院的防控措施差异较大。建议各医疗机构分析VAP护理防控实践的薄弱环节,并开展相关培训和质量控制,进一步完善持续质量改善工作机制,从而有效降低VAP的发生率。

Objective To investigate the nursing clinical practice of ICU ventilator-associated pneumonia(VAP)prevention and control of tertiary hospitals in China,and analyze relevant countermeasures.Methods A self-designed questionnaire consisted of 3 parts and 26 items.A questionnaire survey was conducted among nurses in 380 ICUs in 194 tertiary hospitals in 26 provinces from September 1 to 15,2021,using the convenient sampling method.Results A total of 380 valid questionnaires were collected,with an effective rate of 100%.In the system process,369(97.11%)ICUs had files to prevent VAP;291(76.58%)ICUs had a checklist of measures to prevent VAP clustering;274(72.11%)ICUs had continuous improvement projects about VAP in the last 3 years.In the aspect of body position management,semi-decubitus position was the first choice for the patients with invasive mechanical ventilation of 338(88.95%)ICUs.For nursing operation,224(58.95%)ICUs used Subglottic suction,and 128(33.68%)among them used air shock to remove the retention on the balloon;normal saline is still routinely injected before sputum aspiration in 72(18.95%)ICUs.In terms of balloon pressure monitoring,253(66.58%)ICUs did the oral care 3-4 times a day.In the balloon pressure monitoring,313(82.37%)ICUs use airbag pressure gauges to intermittently monitor airbag pressure;293(77.11%)ICUs replaced the ventilator pipeline once a week.There are significant differences in the current practice status of different types of ICUs in terms of compliance strategies for bed head lifting,subglottic secretion drainage,airbag pressure monitoring,and oral care(P<0.05).Conclusion At present,the relevant systems and procedures to prevent VAP have been improved,but the specific prevention and control measures need to be further unified.Therefore,it is suggested to analyze the weak links of VAP nursing prevention and control practice in various medical structures,carry out relevant training and quality control for the weak links,and further improve the working mechanism of continuous quality improvement,thus effectively reduce the incidence of VAP.